Epidemiologists Archie Clements and Christopher Reid discuss COVID-19’s global disruption and how this experience will help us prepare for future pandemics.
Prior to COVID-19, you might not have anticipated that a virus could have such a profound global impact in the 21st century.
To discuss the impact of COVID-19, what researchers can learn from it, and what the future might hold, David talks to Professors Archie Clements and Christopher Reid, both from Curtin’s Faculty of Health Sciences.
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You can read the full transcript for the episode here
This is The Future Of, where experts share their vision of the future and how their work is helping shape it for the better
Who would've thought something so small could wreak so much havoc? Prior to COVID-19, you probably didn't think that a virus would cause this much global disruption. To discuss the impact of COVID-19 on the future of pandemics, with me today are two research epidemiologists, Professor Archie Clemens and Professor Christopher Reid, both from Curtin University's Faculty of Health Sciences. Thank you very much for coming in today, Archie and Chris.
Professor Archie Clements (00:41):
Professor Christopher Reid (00:42):
Archie, you would have been aware that a pandemic could cause this sort of global disruption. Why has it taken this long for a virus to impact the world in such a massive extent?
Professor Archie Clements (00:58):
Well, obviously, there have been pandemics happening throughout the last 100 years. The last big one that was this disruptive was the Spanish flu pandemic in 1918, but there have been multiple pandemics since then. It's just that those pandemics have all been able to be contained or were not as... didn't cause us such a hard burden of illness and death.
There are a bunch of reasons why this pandemic's particularly bad. The first is the virus itself. It's a highly contagious virus, and it's also a virus that in a small proportion of people can cause very serious illness. Apart from that, I think the world's changed over the last 100 years. We're more connected than we've ever been. Air traffic has expanded at an incredible rate. We travel far more than we did even 10 years ago, and that's really facilitated the spread of the virus.
On top of that, there are a number of issues around how the global response to the pandemic was managed. A number of countries didn't really heed the World Health Organization warnings that were put in place earlier in the year. The Director-General of the WHO was very open and explicit in pleading for countries to be prepared and many countries ignored those warnings to their peril, and as a result, the epidemic in each of those countries has been much worse than it needed to be to.
Professor Christopher Reid (02:30):
Archie, I think your point about the amount that the world currently moves and how viruses now can spread far beyond what we would have really thought manageable. This has been, I think, such a... Well, on demonstration, so much in this current pandemic, when it really, in those very early days, the constant movement of people in and out of different airports, it just saw this explode on the world stage. I can't think of anything that we've seen like this before.
Professor Archie Clements (03:06):
I think that's true. I think the amount of international travel, the international connectivity, the way that goods and services are traded, the mobility of the global workforce. We have people from China, for example, working throughout the world, in Iran, Italy, Africa, and that is all new. But also, I think what this epidemic did was really expose a lack of preparedness. Countries weren't ready for a pandemic like this, other than a small number of countries that have invested quite heavily in pandemic preparedness for many years, Australia included.
We know that COVID-19 affects the respiratory system, but we're still trying to work out how it affects other parts of your body. Obviously, all of the parts are important. Chris, you're involved in a study that's investigating the potential long-term impacts of COVID-19. What are you hoping to reveal?
Professor Christopher Reid (04:08):
Yeah, look, that's right, David. As Archie indicated, many people will be exposed to the virus, many people will be infected. Hopefully, only a relatively small number will have very serious consequences. And so, many people will be actually living with having been exposed to COVID-19. And already, right in the early days, we saw some suggestions that it may actually be of impact to people with underlying chronic health conditions, particularly underlying cardiovascular disease, people with diabetes, people, with hypertension, et cetera. And so, in the absence of any information, we felt it was really important to try to start gathering some information on longterm exposure and to try to see whether we're able to determine whether there are any increased risks associated with background co-morbid conditions such as, as I say, such as heart disease.
What's also important at the moment is that we're also interested in looking at the longterm impact of how the communities responded to managing COVID-19. Certainly, colleagues working in the mental health space are particularly interested in the impact of, for example, isolation, the community strategies that have been implemented really right around the world, and what the importance of health implications may be having been exposed to that type of a situation. Something which we haven't been... Well, we haven't seen that certainly in our country before.
How is Australia performing in terms of that response?
Professor Archie Clements (05:56):
Well, in my view, Australia's performed extremely well. And as I mentioned earlier, we have, over many decades, trained our pandemic response workforce, and their skills have been honed through investigating many small outbreaks over the years in preparation for having to deal with a big pandemic. I think we've performed well at multiple levels, certainly at the level of government. I think the putting aside of political differences and the creation of a national cabinet that has enabled national coordination of the pandemic response has been very successful. When you have a country that's a federation of multiple jurisdictions, you always face challenges in coordinating cross-boundary responses to health challenges like that, and I think that this approach the government's used has been very effective.
We've seen fairly consistent messaging between the Commonwealth and the states. In a pandemic, it's really important that you have strong leadership. You need leadership that provides clear and consistent messaging, that makes decisions on the basis of evidence, that's open and collaborative, and that can inspire the trust of people, and I think that our government has been able to do that. I think at a health system level, we are... Where we have an incredibly strong health system, one of the strongest health systems in the world. I think there certainly were glitches. I think there was a lot of anxiety and fear in the health system, but it did mobilize very quickly in order to be able to handle a surge in cases that, fortunately, hasn't actually materialized.
And then, of course, there's the public, and I think that the public has responded incredibly well. We have clearly got a lot of trust in this country, a lot of social cohesion. People heeded the warnings of the government. People exercised good practice when it came to social distancing, personal hygiene. People stayed informed. I don't want to suggest that the situation in Australia's been perfect, but I do think it has been very good and that really has been reflected in the numbers. We have very few cases in Australia at the moment.
Professor Christopher Reid (08:16):
It's certainly been one of the envies, so I think, looking globally, Australia's response has been terrific. I think, Archie, also, I've heard some comments that people would like to see this national cabinet stay. It seems to have been very, very effective in bringing in that cohesion, bringing in consistent messages, allowing formulation of good policy in relation to managing the situation, but also allowing those sort of slight variations across states, depending on their individual situation. It certainly has been something I think people would like to see continue in some way or form.
Professor Archie Clements (09:05):
Yeah. I think you make a good point there about the fact that each state and territory has different natural advantages and disadvantages. Obviously, in Western Australia, we have the advantage of isolation and we can use that to good effect in a pandemic, and the other regional and state border closures have been an important strategy. Clearly, the international border closure is the key strategy. I mentioned evidence-based decision making. Another thing that we have in this country is we have very good infectious disease modelers, who are internationally connected, who collaborate globally, who have access to the world's best modelers in countries like the United Kingdom. We share knowledge and information, and that directly feeds into advice that goes to government, and I think we can be proud of the role that our scientists have played.
Professor Christopher Reid (09:56):
Yeah. And it's been really, really interesting to watch the way that the government has really taken on board the expert advice, and that's something that I think has been really well demonstrated. The policies are being made on the basis of evidence, on the basis of forecasting, and in response to the situation at hand. So, it's been a really, really nice demonstration of how important that sort of evidence-based platforms do inform on policy and create really good government and good policymaking at a time when the population really needs it. I think we can all think of examples of around the world where we're probably not seeing that anywhere near to the extent that we've seen here in Australia.
Why is it so difficult to create a vaccination for coronavirus? We weren't able to get vaccinations for SARS and MERS that we're able to quite rapidly deploy vaccinations in comparison for things like influenza. Why is it so difficult to vaccinate against these sorts of viruses?
Professor Archie Clements (11:14):
Well, every virus is different and they interact with the human immune system in a different way, and it just so happens that the coronaviruses are viruses that interact with... Well, they invade the upper respiratory tract, is part of the issue. The upper respiratory tract has a very different immune system to, for example, the lungs, and it's very challenging to get vaccines that trigger the right part of the immune system in order to respond to coronavirus infection. So, that's part of the issue. Given that we don't have a long history of developing coronavirus vaccines, there isn't that body of scientific work that we can draw on rapidly, which is different to influenza viruses where... We see seasonal influenza epidemics every year. There's a global structure put in place for sharing information in order to create new vaccines for influenza every year.
It also happens that influenza is dealt with by parts of the immune system that are relatively straightforward in terms of vaccine development. So, it's a combination of the virus itself, the way that it interacts with the immune system, and the fact that we don't have a long history and body of scientific knowledge around the development of vaccines for this particular class of virus.
Professor Christopher Reid (12:41):
I think it's also important that the messaging around how long it actually may take to develop a vaccine for coronavirus and managing community expectations though. I think that's also pretty important. This is not going to be solved immediately. This will take quite a long time because of the points that Archie's raised. And I think it's really important that, in the absence of a vaccine, this is a very highly contagious virus and therefore, those strategies, which are currently being recommended around containment are probably likely to be with this for some time.
Professor Archie Clements (13:27):
Yeah. I definitely agree with that. I'm hopeful that we will have a vaccine in due course. I don't think... The predictions that it might take a year to 18 months are, I would suggest, a minimum. And absolutely, the coronavirus is going to be with us for all of that time, and we have to be vigilant. We have to be prepared to go back into social distancing and other restrictions as and when needed. We also have to expect that our borders are going to be closed for quite some time and that there will be restrictions on travel, and that life won't return fully to normal for a number of years.
There are quite a few unanswered questions when it comes to how this pandemic started. Realistically, will we ever get a clear answer, and have we actually been able to in the past?
Professor Archie Clements (14:26):
Well, in my opinion, we do have a pretty clear understanding of how the epidemic started. I think there is a lot of obfuscation and a lot of politicization of that particular issue. I'm not a politician, so I don't pretend to know how these issues should be dealt with from a political perspective, but it's very clear that wildlife in parts of the world, particularly bats, carry many, many different types of coronavirus. It's very clear that as a result of greater human incursion into natural environments, greater fragmentation of natural environments, trade in wild animals, either for food or traditional medicine, increases the exposure of humans to the variety of coronaviruses that wild animals carry.
So, that is the most plausible explanation. It's the one that all the evidence points to. That this was a spillover from a natural wild host into the human population, probably through the food chain, probably through live animals being present in wet markets in Wuhan Province in China. I don't think there's a lot of serious doubt that that's the case in the scientific community. I think any doubt around that has really been generated through political discourse, not through scientific argument.
Professor Christopher Reid (15:52):
Yeah. Look, I certainly agree with that. I think it's also important to note that these sorts of virus transmissions can happen and have happened right around the world. It's not just an issue about a particular country. We've had our own virus develop here in Australia when the Hendra virus was transmitted from, firstly, I think, bats to horses, and then eventually, with handling and close contact, transmitted to humans.
And so, I think there really is a clear pathway about how this was actually started, and some of the alternative hypotheses, I don't really believe have a strong evidence base.
Professor Archie Clements (16:44):
Yeah. I think maybe a better question might be how did the virus take off? How did the virus move from being a relatively contained epidemic in one country to a global pandemic and what responsibility do governments around the world have for that? I think that, for me, is the real question. If we are to do an investigation, and we will. The WHO investigates every pandemic that happens. Those will be the questions that'll be asked. We need to learn from this pandemic because there will be another one.
The number of examples of pathogens spilling over into the human population from animal populations and triggering epidemics and pandemics is growing very quickly, so there will be another one. It won't be in a hundred years' time. It will be much sooner than that, and we need to learn from this so that we can manage it better in the future. In order to learn from it, we need to, as much as we can, avoid politicization, and we need to go back to the science, and we need to look at the evidence.
Professor Christopher Reid (17:58):
That preparedness that you mentioned earlier, Archie, I think is a really important issue. I mean, we've seen some of the countries that have been able to respond and have been able to implement strategies, have that level of preparedness. I think that is something that's going to come from the experience that's happening right around the world at the moment, is the importance of having systems in place. Knowing what to do, when to do it, and how to coordinate it. I think we've all learned... all learning, still learning, as a result of these. But probably, that will be the ones one big step forward that we will make right around the world, is increasing that level of preparedness for, as you say, the next pandemic outbreak, whenever and wherever that may occur.
Do you think this pandemic is going to have a lasting impact on humanity and how we function as a society? Are we going to be more conscious about things like hygiene and personal space, for example, or perhaps more wary about travel?
Professor Archie Clements (19:06):
I'll let Chris answer that one, I think.
Professor Christopher Reid (19:08):
Yeah. Look, I think it will have. It's certainly probably had the biggest impact that certainly we've seen in our lifetime, without a shadow of doubt. Its impact on the economy, I think, is yet to really be clear. But we do know that it's had a huge, and it is having a huge impact on the economy. And I think those very basic issues around good personal hygiene, personal space, et cetera, I think they probably will be with us for a bit longer.
But one of the things I did want to just sort of touch on, the effect of the virus. An interesting thing we've seen in the hospital sector since this pandemic has occurred, and particularly here in Australia, we've seen a dramatic drop off of people actually attending for their routine health care for the management of their chronic health conditions. That in itself is also going to have a major impact, not only now, but also on future rates of diseases. Cardiology departments around the country have literally been empty, and it's not because people aren't having heart attacks and aren't suffering from cardiovascular disease. It's because they're not actually... They're a little bit nervous about getting out and getting support and getting treatment for it.
So, I think we are going to see a lasting effect. How extensive that will be, we don't know yet. That's also why it's important to actually ensure that we do have a good handle on the longterm implications, particularly for those people who may be more at high risk, those people with chronic health conditions, because it is going to have an impact. Not just now, but it's likely to be continued certainly for a number of years.
Professor Archie Clements (21:15):
Yeah. I agree with Chris, that those are the types of impacts that we're likely to see. I work in infectious diseases. If you look at the disease, tuberculosis, it tends to be spread in households. If you have people restricted to the home, you're actually more likely to see transmission of infections like tuberculosis, a bacterial infection that's spread also through the air, through coughing and close physical proximity. That's like cardiovascular disease, in a sense. It's a disease that doesn't present itself immediately. It presents itself down the line, in a number of years, due to the long latency period of the infection. And so, we may see negative health consequences that are not directly related to coronavirus but are indirectly related, for a number of years.
So, I actually think that's probably one of the areas where we will say a long-term impact. I'm not convinced that we will see significant social change or behavioral change. Behavior is incredibly difficult to change. If anyone knew how to create sustainable behavior change in response to a public health problem, they would probably win the Nobel Prize because it's so difficult to do. So, yes, whilst we may have economic consequences that in themselves could lead to health consequences, a lot of diseases around the world are made worse by poverty, and poverty is likely to grow as a result of the economic disruption, I'm not a hundred percent convinced that we will actually see human behavior change in a sustainable way.
I think we'll leave it there then. Thank you very much, Archie and Chris for coming in and sharing your knowledge on this topic.
Professor Archie Clements (23:10):
Professor Christopher Reid (23:11):
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